Report of 73 cases of cutaneous sporotrichosis in Mexico

Abstract: We report 73 cases of cutaneous sporotrichosis from the Community Dermatology program, at the central and mountain areas of the state of Guerrero, Mexico. A similar number of cases was found between children and adults, mostly peasants and school-age children with rural occupations. Upper limbs were the mostly affected and the predominant clinical form was lymphocutaneous (56.16%). All cultures corresponded to Sporothrix schenckii (sl). Treatment was done with potassium iodide in 54 patients, achieving clinical and mycological cure in all cases.

Report of 73 cases of cutaneous sporotrichosis in Mexico.

We report 73 cases of cutaneous sporotrichosis from the Community Dermatology program, at the central and mountain areas of the state of Guerrero, Mexico. A similar number of cases was found between children and adults, mostly peasants and school-age children with rural occupations. Upper limbs were the mostly affected and the predominant clinical form was lymphocutaneous (56.16%). All cultures corresponded to Sporothrix schenckii (sl). Treatment was done with potassium iodide in 54 patients, achieving clinical and mycological cure in all cases.

Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed Scabies.

The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients and pharmacists. This report documents a series of eight cases of iatrogenic Cushing syndrome secondary to an inappropriate use of topical steroids, due to a misdiagnosis of scabies.

Cervical and middle dorsal actinomycetomas from Guerrero State, Mexico.

BACKGROUND: Mycetomas are frequent subcutaneous mycoses with typical clinical characteristics such as sinuses, blood-stained, serous, or purulent exudates as well as local swelling. Even though the most commonly affected areas are the lower limbs, we report four cases affecting the neck and midback regions, of which three were young females. We draw attention to the importance of early identification of these cases for prevention and specific treatment in order to avoid severe consequences or irreversible complications such as quadriplegia. OBJECTIVE: To document the occurrence of cervical spine and middle dorsal thoracic mycetomas, as well as their severity, clinical manifestations, and secondary complications. MATERIAL AND METHODS: This was an observational and descriptive study in which we reviewed cases with neck and middle dorsal thoracic mycetomas diagnosed at the Acapulco General Hospital of Guerrero State, Mexico. We describe the cases including the mechanism of inoculation, neurological symptoms, and severity. CONCLUSIONS: We describe three cases initially diagnosed clinically as cervical mycetomas and one in the middle dorsal thoracic region. All the cases were diagnosed at the Acapulco General Hospital of Guerrero State in Mexico.

Specialized dermatological care for marginalized populations and education at the primary care level: is community dermatology a feasible proposal?

Skin diseases have a very high frequency either in developed as well as in undeveloped countries. Guerrero, Chiapas, and Oaxaca are the most impoverished states in Mexico, where 24% of the population lacks basic health care, and only 15% are estimated to have access to specialists. Community Dermatology program was founded in 1991 with the intention of improving the dermatological health of remote, marginalized inhabitants of the state of Guerrero. The program consists of a two-day visit to a pre-selected community; the first day includes a basic dermatology training course for local providers, and day 2 is a "Jornada",which means a day of free medical consultation and treatment. Pityriasis albus Cloasma, vitiligo, and acne continue to be the most frequent diagnosed primary disorders, as in rural areas occupational obligations include prolonged sun exposure. The experience and success of Community Dermatology over the last 20 years has demonstrated that this model of healthcare delivery and instruction is economically feasible, provides practical and quantifiable benefits for the communities served, and could be emulated by other disciplines within medicine.

Eumycetoma.

Eumycetoma is caused by different fungi. Madurella mycetomatis, Madurella grisae, and Scedosporium apiospermum are the most common causative agents. This disease is more frequent on the lower extremities but can also be present in other areas. The diagnosis is made by direct microscopic examination and histologic study, which should show hyphae and vesicles characteristic of the fungi. Etiologic identification of the species of the fungus is sometimes difficult by culture and biopsy specimen; in these cases, molecular techniques can help to identify the infecting organism. Treatment has been with amphotericin B, which is now seldom used due to its side effects and limited success. The best therapeutic choice is surgical removal of the lesion, followed by medical treatment. This includes antifungals such as the azoles, ketoconazole and itraconazole; in resistant cases, posaconazole and voriconazole are currently recommended. In particular, the combination of terbinafine and itraconazole can elicit a good result in some cases.

Eumycotic mycetoma caused by Madurella mycetomatis successfully treated with antifungals, surgery, and topical negative pressure therapy.

We report a 21-year-old farmer with a 4-year history of a nodular plaque with fistulas and induration of adjacent skin. The lesion had been treated surgically at another hospital, but recurred 2 years later. Black, charcoal-like grains were observed draining through the fistulas. A biopsy specimen showed brown grains with filaments in an abscess surrounded by macrophages, giant cells, and lymphocytes. Culture demonstrated small white colonies of Madurella mycetomatis. The patient was treated with itraconazole for 6 months, followed by surgery. TNP was initiated in the immediate post-operative period, and copious granulation tissue was observed within 1 week. Autologous skin grafting was performed, and itraconazole was continued for an additional 3 months. Although necrosis of the graft ensued, the functional result was acceptable. The patient appeared free of disease at 18 months of follow-up. Eumycotic mycetoma is an infectious and inflammatory process that occurs after traumatic inoculation of fungi through the skin. Surgery is the treatment of choice, but successful reconstruction may be challenging and recurrence is common. Topical negative pressure (TNP) promotes the formation of granulation tissue, which facilitates closure of deep wounds and chronic ulcers. This case illustrates that eumycotic mycetoma is difficult to treat. Whether TNP contributed to the successful outcome cannot be proven but, given the generally poor response of eumycetoma to therapy, we suggest that the role of TNP in the management of this disease merits attention.

Gnatostomiasis humana: Informe de cuatro casos con confirmación histológicatractos de placenta humana (Melageninas I y II) / Human gnathostomiasis: a four cases report confirmed by histopathology

La gnatostomiasis humana es una enfermedad causada frecuentemente por el Gnathostoma spinigerum, sin embargo, se reportan cada vez más frecuentemente otras especias en la literatura mundial. El presente trabajo tiene por objeto la comunicación de cuatro casos que tuvieron confirmación histológica, provenientes de Acapulco, Gro. México

Epidemiología cutánea en dos sectores de atención médica en Guerrero, México / Cutaneous epidemiology in two sectors of Guerrero, Mexico

Se realizó un estudio epidemiológico en tres hospitales de la ciudad de Acapulco y en 41 comunidades representativas del estado de Guerrero. Se incluyeron 7,626 entrevistas casa por casa, cubriendo 50,000 personas. En el 50 porciento de las casas encuestadas alguna persona presentó problemas de la piel. El 60 por ciento de la patología dermatológica encontrada (total=4,355 consultas) está comprendida en 10 diferentes diagnósticos; las dermatosis más frecuentes fueron la escabiasis y pitiriasis alba. La consulta externa más solicitada en el Hospital General de Acapulco en los últimos cinco años fue la de dermatología; esto indica la conveniencia de establecer un programa de capacitación en dermatología comunitaria, dirigido al personal en el primer nivel de atención de la salud, donde se puede atender la mayoría de estos problemas.